Oral Communication

Tolerance of very early exercise in intensive care unit based on a decisional algorithm: a pilot feasibility study

Mrs Hélène LAURENTa, Mrs Sylvie AUBRETONb, Prof Ruddy RICHARDc, Mr Yannael GORCEd, Mrs Emilie CARONd, Mrs Aurélie VALLATd, Mrs Anne-Marie DAVINa, Prof Jean-Michel CONSTANTINe, Prof Emmanuel COUDEYREf

a Physical Medicine and Rehabilitation Department, Gabriel Montpied University Hospital, Clermont-Ferrand, b Physical Medicine and Rehabilitation Department, Clermont-Ferrand University Hospital, c Department of Sport Medicine and Functional Explorations, Gabriel Montpied University Hospital, Clermont-Ferrand; INRA UMR 1019, CRNH-Auvergne, d Physical Medicine and Rehabilitation Department, Estaing University Hospital, Clermont-Ferrand, e Adult Intensive Care Unit, Estaing University Hospital, Clermont-Ferrand; Medicine Faculty, University of Auvergne, Clermont-Ferrand, f Physical Medicine and Rehabilitation Department, Clermont-Ferrand University Hospital; Medicine Faculty, University of Auvergne, Clermont-Ferrand

Objective: Practice guidelines recommend early physical therapy in intensive care unit (ICU) [1]. We aimed to evaluate the tolerance of an early exercise program in ICU based on a decisional algorithm issued from the evidence based data and an experts opinion

Methods: In this pilot feasibility study, main outcome collected before and after exercise session is discomfort on a Visual Analogue Scale (VASdiscomfort). Secondary outcomes are muscle strength (Medical Research Council scale), length of stay on ICU, mortality in ICU and place for discharge destination. The standardized program includes an upper and lower limbs (LL) training (cycloergometer for LL and manual range of motion) and a functional training, delivered by a physical therapist. The progression is based on fixed VASdiscomfort threshold at 7/10 during exercise and on algorithm constructed from a systematic review of literature [2], using the Consort recommendations and the PEDro grid

Results: 30 patients were recruited, a total of 150 training sessions were made daily and overall tolerance of an early exercise program in ICU, based from an algorithm applied to the ICU patients is good. We confirm the feasibility of such programs and the very few benign adverse events rate. We note a low incidence of polyneuromyopathy diagnosis

Conclusion: Tolerance of an early exercise program in ICU based from an algorithm is good, but these preliminary results remain to be confirmed in a prospective randomized controlled trial. However, the use of this decisional algorithm should be encouraged to standardize and to initiate progressively very early exercise programs in ICU

[1]. Gosselink R, Bott J, Johnson M, Dean E, Nava S, Norrenberg M, et al. Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy for Critically Ill Patients. Intensive Care Med 2008; 34(7): 1188-99

[2]. Laurent H, Aubreton S, Richard R, Gorce Y, Caron E, Vallat A, et al. Systematic review of early exercise in intensive care: a qualitative and practical approach about literature. Anaesthesia Critical Care and Pain Medicine 2015 (in press)

Keywords : algorithm, critical illness, early exercise, feasibility, intensive care unit, physical therapy